1 >>A 19-year-old normal nonsmoking woman has a moderately severe pulmonary embolism while on oral contraceptive pills. Which of the following is the most likely predisposing factor? ?
- (A) Abnormal factor V
- (B) Abnormal protein C
- (C) Diminished protein C level
- (D) Diminished protein S leve
2 >>Which of the following is a typical manifestation of chronic hyperventilation? ?
- (A) Hypoxemia
- (B) Hyperphosphatemia
- (C) Tetany
- (D) Increased frequency of thromboembolic disease
3 >>Dendritic cells are critical components of the immune system because they ?
- (A) produce antibodies that bind to specific microorganisms
- (B) are capable of directly recognizin
- (C) present antigens to lymphocytes in the context of the MHC and co-stimulatory molecules present on their cell surface
- (D) engulf microorganisms and kill them by secreting toxic substances such as superoxides, hydroxyl radicals, and lysozyme
4 >>Which of the following is the LEAST common immunologic manifestation of HIV infection? ?
- (A) Cutaneous reactions to drugs
- (B) Anaphylactic reactions to drug
- (C) Anticardiolipin antibodies
- (D) Oligoarticular arthritis
5 >>Which of the following conditions would be likely to result in an increased residual volu ?
- (A) Chronic obstructive pulmonary disease
- (B) Sarcoidosis
- (C) Interstitial lung disease
- (D) Obesity
6 >>A 51-year-old man develops pancreatitis associated with the passage of a gallstone. His treatment includes meperidine and intravenous normal saline. Two days later he becomes anxious, tachypneic, and short of breath. An emergency chest x-ray demonstrates diffuse, bilateral interstitial and alveolar infiltrates. A year ago he suffered a myocardial infarction, but since then he has had no evidence of congestive heart failure. In this case, adult respiratory distress syndrome can be distinguished from cardiogenic pulmonary edema by which of the following? ?
- (A) Measurement of lung water
- (B) Measurement of pulmonary artery wedge pressure
- (C) Measure of lung compliance
- (D) Abnormal protein C
7 >>The same patient arrives in your office 72 h later with progressive symptoms. He is still complaining of continued low-grade fevers to 38.3C (101F). His cough is now productive of yellow greenish thick phlegm and is protracted, often resulting in vomiting. He denies any headache, sinus tenderness, or maxillary tooth pain. You prescribe which of the following? ?
- (A) Dexbrompheniramine plus pseudoephedrine
- (B) Nonsedating antihistamine
- (C) Erythromycin
- (D) Ampicillin with clavulanic acid
8 >>A 25-year-old man with cystic fibrosis undergoes a double-lung transplantation. He is now 60 days posttransplant. He presents to your office complaining of malaise, low-grade fevers, dyspnea, and a nonproductive cough. His room air oxygen saturation is approximately 88%, his chest x-ray is unchanged from baseline, and spirometry shows a 15% decline from those results obtained 3 weeks earlier. A bronchoscopic lung biopsy reveals perivascular lymphocytic infiltrate. Which of the following would be the most reasonable next step? ?
- (A) Start erythromycin
- (B) Start intravenous piperacillin and gentamicin
- (C) Administer high-dose methylprednisolone
- (D) Administer inhaled glucocorticoids
9 >>A 72-year-old woman presents with an acute onset of pleuritic chest pain, dyspnea, and tachycardia 2 days after fracturing her left foot misstepping on an uneven sidewalk. During those 2 days the patient has spent most of her time bedridden. The patient is brought by ambulance to the emergency room. A ventilation-profusion scan (V/Q) is performed confirming the clinical suspicion ? ? of a pulmonary embolism. Which of the following treatment recommendations is likely to result in a decrease in a recurrent thromboembolic event? ?
- (A) Initiation of heparin only until the patient is fully ambulatory; once ambulatory, no further treatment is indicated
- (B) The initiation of warfarin and heparin simultaneously
- (C) The initiation of warfarin once a therapeutic partial-thromboplastin time has been achieved, and then the warfarin continued for an additional 6 weeks
- (D) The initiation of warfarin once a therapeutic partial-thromboplastin time has been achieved, and then the warfarin continued for an additional 6 months
10 >>A 35-year-old premenopausal woman presents with the diagnosis of pulmonary hypertension. She complains of dyspnea, nonproductive cough, and recurrent episodes of chest pain. Part of her pulmonary workup includes a bronchoscopy with a bronchoscopic biopsy. Histologic review of the biopsy specimen reveals pulmonary lymphangioleiomyomatosis (LAM). Which of the following statements concerning pulmonary LAM is correct? ?
- (A) Pulmonary LAM is more common in blacks than whites.
- (B) Hemoptysis is common but seldom lifethreatening
- (C) Pulmonary function tests often show a clear restrictive pattern
- (D) A chylous pleural effusion is a common complication
11 >>Which of the following is a likely mechanism for this observation? ?
- (A) Hyperkalemia
- (B) Relaxation of the compensatory vasoconstriction
- (C) Hypoglycemia
- (D) Bronchial hyperresponsiveness
12 >>Which of the following statements concerning central sleep apnea (CSA) is true? ?
- (A) CSA is more common than obstructive sleep apnea (OSA) in patients with heart failure
- (B) Daytime hypercapnia is not seen in patients with CSA.
- (C) Obesity is a common finding
- (D) CPAP is not effective in treating patients with CSA as opposed to the treatment of patients with OSA.
13 >>A patient with lymphoma who is known to excrete 1.5 g urinary protein per day has a negative dipstick evaluation for urinary protein. The reason for the seeming inconsistency is ?
- (A) the size of the excreted protein is too small to be picked up by the test strip
- (B) the urine is not concentrated enough
- (C) only heavy chain sequences are recognized by the test strip
- (D) dipsticks preferentially detect albumin compared with immunoglobulin because albumin is negatively charged
14 >>A 75-year-old female nursing home resident is brought to the emergency department because of increasing obtundation. She is found to communicate poorly. Brief physical examination reveals diminished skin turgor. Blood pressure is 100/60, pulse 120, respiratory rate 20, and temperature 37�C (98.6�F). Blood tests reveal the following serum electrolytes: sodium 160 mmol/L, potassium 5.0 mmol/L, bicarbonate 30 mmol/L, chloride 110 mmol/L. The most appropriate management at this time would include administration of 5% dextrose in ?
- (A) normal saline, 100 mL/h
- (B) normal saline solution, 250 mL/h
- (C) half normal saline, 100 mL/h
- (D) water, 150 mL/h
15 >>A 45-year-old woman who has had slowly progressive renal failure begins to complain of increasing numbness and prickling sensations in her legs. Examination reveals loss of pinprick and vibration sensation below the knees, absent ankle jerks, and impaired pinprick sensation in the hands. Serum creatinine concentration, checked during her most recent clinic visit, is 790 ?mol/L (8.9 mg/ dL). The woman’s physician should now recommend ?
- (A) a therapeutic trial of phenytoin
- (B) a therapeutic trial of phenytoin (B) a therapeutic trial of pyridoxine (vitamin B6 )
- (C) a therapeutic trial of cyanocobalamin (vitamin B12 )
- (D) initiation of renal replacement therapy
16 >>A 23-year-old man has recurrent episodes of hematuria over the past year. Each of the episodes seems to be associated with an upper respiratory infection. Physical examination currently is normal. Urinalysis reveals a relatively bland sediment; dipstick is positive for both protein and blood. Renal biopsy most likely will reveal ?
- (A) extensive extracapillary proliferation on light microscopy
- (B) diffuse mesangial proliferation on light microscopy
- (C) autosomal dominant polycystic kidney disease
- (D) diffuse mesangial deposition of IgA on immuno- fluorescence
17 >>Which of the following case histories would most likely be associated with the urinary sediment depicted? ?
- (A) A 23-year-old man with newly diagnosed lympho blastic lymphoma who is found to have a rising creatinine level 2 days after the administration of combination chemotherapy
- (B) A 23-year-old woman 1 year after surgery per formed because of morbid obesity
- (C) A 45-year-old woman with a history of multiple urinary tract infections with urea-splitting orga nisms
- (D) A 40-year-old man with edema, hypoalbuminemia, and proteinuria
18 >>A 72-year-old woman with rheumatic heart disease is being treated with ampicillin and gentamicin for enterococcal endocarditis. One week into the course she develops a morbilliform skin rash and fever. Laboratory evaluation is remarkable for a doubling of serum creatinine and blood urea nitrogen from their baseline values. Urinalysis dipstick is positive for blood, protein, and white cells. Ultrasonography reveals bilaterally enlarged kidneys. Based on the available data, the most likely cause of the patient’s azotemia is ?
- (A) tubular necrosis caused by aminoglycoside
- (B) membranous nephropathy resulting from endocarditis
- (C) enterococcal pyelonephritis
- (D) hypersensitivity reaction to ampicillin
19 >>A 40-year-old woman who has never had significant respiratory disease is hospitalized for evaluation of hemoptysis. Urinalysis reveals 2 proteinuria and microscopic hematuria. BUN concentration is 7.1 mmol/L (20 mg/dL), and serum creatinine concentration is 177 ?mol/L (2.0 mg/dL). Serologic findings include normal complement levels and a negative assay for fluorescent antinuclear antibodies. Renal biopsy reveals granulomatous necrotizing vasculitis with scattered immunoglobulin and complement deposits. The most likely diagnosis in this case is ?
- (A) mesangial lupus glomerulonephritis
- (B) Henoch-Scho¨nlein purpura
- (C) microscopic polyarteritis
- (D) Wegener’s granulomatosis
20 >>Which of the following patients is most likely to develop destruction of renal papillae with concomitant tubulointerstitial damage? ?
- (A) A middle-aged man who has consumed “moonshine” alcohol distilled in an automobile radiato
- (B) An older man with early-stage prostate adenocarcinoma
- (C) A young adult woman with ?-thalassemia
- (D) An older woman who uses analgesics for chronic headaches
What does the doctor of internal medicine mean? What is the difference between family practice and internal medicine? What do internists treat? Why did you choose internal medicine?